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Kentucky voters create 'a big problem' for themselves

A 36-year-old Kentuckian says without Medicaid expansion, her family faces "a big problem." So why did she vote for the anti-Medicaid expansion candidate?
We talked last week about a middle-aged Kentucky man who relies heavily on Medicaid expansion through the Affordable Care Act, but nevertheless voted for Gov.-elect Matt Bevin (R), who ran on a platform of destroying Medicaid expansion.
“[I]t doesn’t look to me as if [Bevin] understands," the man said, struggling with the consequences of his own vote. "Without this little bit of help these people are giving me, I could probably die." It's a problem that apparently didn't occur to him until after he backed the far-right candidate.
And he's not alone. The Lexington Herald-Leader reported today on Owsley County, Kentucky, where most local residents receive health coverage through Medicaid, but where most local residents also voted for the anti-Medicaid candidate.

Lisa Botner, 36, belongs to both camps. A Kynector -- a state agent representing Kynect in the field -- recently helped Botner sign up for a Wellcare Medicaid card for herself and her 7-year-old son. Without that, Botner said, she couldn't afford the regular doctor's visits and blood tests needed to keep her hyperthyroidism in check. "If anything changed with our insurance to make it more expensive for us, that would be a big problem," Botner, a community college student, said Friday at the Owsley County Public Library, where she works. "Just with the blood tests, you're talking maybe $1,000 a year without insurance."

So why in the world would she support Bevin and vote to undermine her own interests? "I'm just a die-hard Republican," the woman said.
The Herald-Leader article quoted a political scientist who crunched the numbers and found that the Kentucky counties most reliant on Medicaid expansion were also the most likely to vote for the candidate who vowed to tear down Medicaid expansion.
Owsley County Judge-Executive Cale Turner responded, "To be honest with you, a lot of folks in Owsley County went to the polls and voted against gay marriage and abortion, and as a result, I'm afraid they voted away their health insurance."
The news isn't quite as frustrating in Alabama, where about a month ago, Gov. Robert Bentley (R) acknowledged something unexpected: he's starting to see the benefits of Medicaid expansion through the Affordable Care Act. The Republican governor conceded that Alabama has been "realistic" and consider the future of rural hospitals.
Yesterday, Alabama inched a little closer to accepting the "Obamacare" policy that so many Republican officials already hate to love. The Alabama Media Group reported:

A task force appointed by Gov. Robert Bentley today recommended that the governor and the Legislature find a way to provide health insurance for Alabamians without coverage. The Alabama Health Care Improvement Task Force approved a recommendation that said the biggest obstacle in improving health is the "coverage gap that makes health insurance inaccessible to hundreds of thousands of Alabamians." The majority of that group [is made up of] working people who earn too much to qualify for Medicaid but don't have private insurance, according to the Task Force statement.

In other words, Medicaid expansion would expand coverage to roughly 290,000 low-income Alabamians, most of whom already have jobs, but who are nevertheless caught in the gap created by Republican opposition to the ACA.
If Bentley intends to yield to arithmetic and move forward on Medicaid expansion, he just received some pretty powerful ammunition.
One wonders how much longer it will take for other states to do the same. Georgia, which has struggled with rural hospitals closing because state Republicans refuse to consider Medicaid expansion, saw another facility announce last week it will permanently close in December -- the "fifth rural Georgia hospital to shut its doors since 2013."